Cough Syrup Addiction: The Dangers of Abusing Codeine

Codeine cough syrup is a commonly used prescription medication that contains codeine, a mild opioid, and often promethazine, an antihistamine. Doctors prescribe it to people with stubborn coughs. When the medication is used correctly, it helps relieve symptoms and promote rest. But when misused, it can lead to serious health risks, including addiction, overdose, and death. Codeine cough syrup is just one of several cough and cold medicines, and cold medications, including over the counter medication, are sometimes misused for their abuse potential. Over the counter cough medicines containing DXM are widely available, which increases the risk of misuse and potential health dangers, especially among teens.

Many people misuse this syrup to get high, calling it “lean”, “purple drank”, or “sizzurp.” There are many slang terms for these substances, and substance abuse involving cough and cold medicines is a growing concern. There has been a rise in cough syrup abuse, which now includes not only codeine but also other drugs like dextromethorphan (DXM). Cough medicine abuse can involve DXM, which is sometimes combined with other drugs, increasing the risks. This trend is especially popular among teenagers and young adults, partly due to pop culture and social media. But behind the hype lies a dangerous drug with powerful effects on the brain and body.

DXM is available in pill forms, such as capsules and tablets, and is sometimes referred to by slang terms like dextro drix gel groove. DXM products are widely accessible and can be misused if not used as directed.

Parents and caregivers should discuss OTC medicine safety with teens to help prevent misuse. It is also important to use prescription medicines responsibly and avoid buying extra OTC medicines to prevent misuse and stockpiling.

What Is Codeine and Promethazine?

Understanding Codeine

Codeine is a prescription opioid used to treat mild to moderate pain and suppress coughing, and is commonly found in cough suppressant and cold remedies. Codeine is classified as a controlled substance due to its potential for abuse and addiction. It works by changing how the brain and nervous system respond to pain. Codeine is in the same drug family as morphine** and heroin**, and even though it’s weaker, it can still be addictive and deadly when abused.

Studies show that opioids like codeine depress the central nervous system, which includes breathing and heart rate. This effect can lead to respiratory depression and, in high doses, can be fatal.

What Promethazine Does

Promethazine is an antihistamine that treats allergies, nausea, and vomiting. It also causes drowsiness. When mixed with codeine in cough syrup, it intensifies the sedative effects, making the user feel extremely relaxed or euphoric. According to the U.S. National Library of Medicine, promethazine enhances the drowsiness caused by opioids, increasing the risk of overdose.

Why People Abuse Codeine Cough Syrup

To Get High

People abuse codeine cough syrup to experience a high, which may feel like floating—a sensation commonly reported during floating regular abuse—euphoria, or a deep calm. Some users report a hallucinations feeling, visual hallucinations, and altered time perception when abusing high doses, which can distort awareness and increase the risk of harm. These effects are typical of dissociative substances like DXM, PCP, and ketamine, which can cause dissociation and other serious mental health risks. This feeling can be addictive. Over time, users need more syrup to get the same effect, which leads to tolerance and dependency.

Influence of Pop Culture

Popular musicians and influencers have glamorized the use of purple drank, leading many teens to try it. In a 2021 study published in Addictive Behaviors Reports, researchers noted that the glamorization of cough syrup in rap music significantly contributes to youth experimentation (source).

Misleading Perceptions

Because it’s a prescription drug, many people assume codeine cough syrup is safer than street drugs. However, this assumption often extends to its non medical use, which is not true. According to the Centers for Disease Control and Prevention (CDC), prescription opioids have caused tens of thousands of overdose deaths in the U.S.

Short-Term Effects of Codeine Cough Syrup Abuse

Sleepiness and Confusion

Abusing codeine syrup often makes people feel very tired, sluggish, dizzy, or confused. The promethazine in the syrup can also affect coordination and cause blurred vision. These effects can impair judgment and increase the risk of accidents. Some users may also experience a coordination panic attack as a psychological reaction, especially at high doses.

Nausea and Constipation

Codeine can upset the stomach and lead to nausea, vomiting, and constipation. The National Institute on Drug Abuse (NIDA) lists these as common short-term side effects of opioid misuse.

Slowed Breathing

High doses of codeine can slow down breathing—a condition known as respiratory depression. If breathing slows too much, it can lead to coma or death. This is especially dangerous when the syrup is combined with alcohol or other depressants, as this combination can cause serious side effects and life-threatening complications.

Long-Term Dangers of Cough Medicine Abuse

Addiction and Dependency

Long-term misuse can result in opioid use disorder (OUD), a medical condition where the person cannot stop using the drug despite its harmful effects. DXM abuse can also result in similar patterns of addiction and dependency. According to SAMHSA, codeine is addictive and requires treatment through behavioral therapy or medication-assisted treatment.

Damage to Liver and Other Organs

Some codeine cough syrups contain acetaminophen, which can damage the liver when taken in high doses. Mixing syrup with alcohol or sugary sodas, as is common in lean, adds further stress on the liver. A study published in Hepatology showed a strong link between long-term acetaminophen misuse and liver toxicity (source). Long-term misuse can cause a range of adverse effects on the liver and other organs.

Mental Health Decline

Abusing codeine cough syrup may increase the risk of depression, anxiety, and cognitive problems. Long-term use affects brain chemistry, making it harder to focus, remember things, or feel motivated; cognitive impairment is a common consequence of long-term abuse. According to NIH research, chronic opioid use alters the brain’s reward system, which can worsen mental health.

Withdrawal Symptoms

Physical Effects

If a person stops using codeine after becoming dependent, they may experience withdrawal. Common symptoms include muscle pain, impaired judgment, sweating, lethargy, chills, runny nose, and diarrhea. These symptoms can start just hours after the last dose and usually peak within a few days.

Psychological Effects

Alongside the physical pain, many people feel irritable, anxious, or depressed during withdrawal. In severe cases, a person loses contact with reality, experiencing disconnection or confusion during withdrawal. These feelings can be intense and may lead people to relapse just to feel normal again. Withdrawal is one of the biggest challenges of overcoming codeine addiction.

The National Library of Medicine explains that opioid withdrawal is rarely life-threatening but can be extremely uncomfortable without medical support.

Risk of Overdose

What Overdose Looks Like

An overdose can occur when someone takes too much codeine cough syrup at once or mixes it with other substances. Signs include slowed or stopped breathing, unconsciousness, blue lips or skin, and pinpoint pupils. Without immediate help, this can lead to death.

Emergency Response and Naloxone

Naloxone (Narcan) is a life-saving drug that can reverse opioid overdoses. It works by quickly blocking the effects of opioids on the brain. In case of a suspected overdose, contact your local poison control center for immediate guidance and support. The CDC recommends carrying naloxone if you or someone you know is at risk of opioid overdose.

Teens and Young Adults at Higher Risk

Social Pressure

Young people often feel pressure to try substances because of peer influence, and teens dextromethorphan abuse—misusing cough medicines containing DXM for psychoactive effects—is a growing concern. They might think it’s harmless fun, especially when it’s presented in music or online videos. But the consequences can be devastating. According to a study in the Journal of Adolescent Health, early exposure to opioid misuse increases the risk of lifelong addiction.

Hiding Use

Unlike smoking or alcohol, lean is easy to hide. Some teens may even keep cough syrup or related substances in their school locker to avoid detection. It’s often disguised as a sweet drink in a cup, which makes it harder for parents, teachers, and caregivers to detect. This secrecy makes it more dangerous because help might come too late.

Getting Help for Codeine Cough Syrup Abuse

Medical Detox and Rehab

Quitting codeine syrup is not easy, but it’s possible with the right help. Mandala Healing Center can help you fully detox from your cough syrup addiction. Medical detox programs offer a safe way to manage withdrawal symptoms. After detox, people often need counseling, group therapy, and ongoing support.

Treatment centers may also offer medication-assisted treatment (MAT), such as buprenorphine or methadone, to help reduce cravings and prevent relapse. According to SAMHSA, MAT combined with therapy is the gold standard for opioid addiction treatment.

Long-Term Recovery

Recovery doesn’t end after detox or rehab. Health syst pharm professionals can assist with medication management and support during recovery. Many people need support for months or even years. This can include therapy, peer support groups like Narcotics Anonymous, and help from loved ones. Staying drug-free requires lifestyle changes and a strong support system.

Final Thoughts

Abusing codeine cough syrup is not a harmless trend. Dangerous trends like abusing otc medicines can lead to addiction, mental health issues, organ damage, and even death. What starts as a fun drink or a way to relax can quickly become a dangerous habit.

If you or someone you know is struggling with cough syrup abuse, talk to a doctor or treatment provider today. The earlier the problem is addressed, the better the chances of full recovery.

Don’t wait until it’s too late. Real help is available, and a healthier future is possible.

Helpful Resources

• SAMHSA National Helpline (1-800-662-HELP) – Free, confidential help for substance use.
• CDC Opioid Basics – Learn about the opioid crisis and how to prevent overdoses.
• NIH National Institute on Drug Abuse – Facts and research on prescription opioid misuse.